Nursing Care Actions to Prevent and Control the Zika Virus ...€¦ · Nursing is a science, the essence and specificity of which is human care, that is, integral care centered on

Nursing Care Actions to Prevent and Control the Zika Virus: AReview

Cheila Maria Lins Bentes1, Marcos do Nascimento Bentes2, Kátia Cilene GodinhoBertoncello3, Selma Regina de Andrade3, Vera Lúcia de Azevedo Lima4 and Maria de

Lourdes de Souza5

1University of State of Amazonas (DINTER UFSC/UEA), Brazil

2HEMOAM Foundation, Manaus, Amazonas, Brazil

3Department of Nursing, Federal University of Santa Catarina (UFSC), Brazil

4College of Nursing, Federal University of Parả (UFPa), Belẻm, Brazil

5Federal University of Santa Catarina, REPENSUL Institute, Florian polis, Santa Catarina,Brazil

Research Article

Accepted date: 01/08/2019;

Published date: 05/08/2019

*For Correspondence:

Maria de Lourdes de Souza, FederalUniversity of Santa Catarina, InstituteREPENSUL, Health Sciences Center, DelfinoConti Street, s/n-Trindade, FlorianỏpolisSanta Catarina, Brazil, 88040-370,

Tel: +55(48)991618333

E-mail: [email protected]

Keywords: Zika virus, Nursing actions,Pregnant women, Infection, Family, Nursingcare.

ABSTRACTIntroduction: The infection caused by Zika virus has had

worldwide repercussion, as it has been associated withcongenital syndromes in children, especially microcephaly, withan impact on public health.

Objective: To identify in the literature care actions provided bynurses to families and pregnant women to prevent and control theinfection.

Method: Review study with data collected from sevendatabases using descriptors and Boolean operators to identifypapers.

Results: The titles, abstracts and key words of 2,628 paperswere read and the full texts of 39 were selected. Two papers wereexcluded after reading the full texts because they did not addressthe objective proposed here, in that they exclusively addressedthe care provided to children. Another 29 papers under theoriginal protocols and protocol update modalities were excluded.Thus, a total of eight papers remained and composed the corpusof this review.

Conclusion: The papers do not report specific actions of nurses,but emphasize pregnancy planning; development of knowledgeconcerning the disease and vaccine; the delivery of health careand social support to the families with children presentingpermanent special needs accruing from the Zika virus disease;and the report of suspected and confirmed cases.

Research & Reviews: Journal of Nursing & Health Science

J Nurs Health Sci | Volume 5 | Issue 2 | July 2019 30

Received date: 15/07/2019;

ỏ

INTRODUCTIONIsolated over 70 years ago in Uganda in the Zika Forest, on the Entebbe Peninsula in 1947 by scientists who studied

the yellow fever virus in Rhesus monkeys? The Zika virus (ZIKV) is an arbovirus of the Flavivirus genus of the Flaviviridaefamily [1]. In 2015, the Brazilian authorities attributed a 20-fold increase in the number of new borns with microcephaly tothe ZIKV virus [2].

Brazil is a country with hot and humid weather. It states present poor environmental structure, among which areinappropriate water supplies and open sewers that work as breeding grounds for mosquitos, which favors the spread ofthe disease, the vector of which is Aedes aegypti mosquito [3,4].

In October 2015, the State Health Department of Pernambuco (SES/PE) reported the occurrence of 26 cases ofnewborns with microcephaly in different health facilities in different regions of the state. With the emergence of anincrease in the number of new cases of congenital anomalies in children of mothers infected with the ZIKV in Brazil, aPublic Health Emergency of National Concern (ESPIN) was declared [5,6].

The outbreak of the disease in Brazil triggered a mobilization in the technical-scientific community, society and worldmedia. The highest incidence was observed for neurological syndromes, particularly microcephaly. Various studies andmuch research have been dedicated to devising vaccines, drugs, insecticides and other devices to contain and preventthe spread of infection and associated diseases. Protocols, reports, manuals, guidelines were published to disseminateknowledge among health workers and the broader society, which resulted in the establishment of partnerships amongvarious social entities such as Centers for Disease Control and Prevention (CDC-USA), Ministry of Health of Brazil, PuertoRico Department of Health, World Health Organization, Pan American Health Organization in order to protect the health ofthe population [7-13].

Nursing is a science, the essence and specificity of which is human care, that is, integral care centered on theindividual, family and community. Nurses perform their practice based on scientific knowledge seeking to keep suchknowledge updated in order to provide quality care [14].

Since 2015, the epidemic of the Zika virus in Brazil has impacted the puerperal pregnancy process, notably in terms ofcongenital abnormalities in children, whose mothers were infected with ZIKV during pregnancy. After the diagnostic ofmicrocephaly was informed by the health professional the partner abandonment the family. The mothers alone neededdispense integral care that brought intense changes with economic repercussions. In general, the mother showed worrywith development of children, fear of falling ill/die, and be unable to care for the child [15-17]. Amazonas, the Brazilianstate with the largest territorial area, with rich biodiversity that is recognized worldwide, did not escape the repercussionscaused by this virus and the stigma of the microcephaly. Taking into account the contribution of nurses to human healthand development in this region, a commitment was made to conduct research addressing this topic. Considering thediversity of studies this theme requires, the following research question was established: What care actions performed bynurses for families and pregnant women to prevent and control the Zika virus disease are reported in the literature.

LITERATURE REVIEWThis is an integrative review that provides synthesis of knowledge and applicability of results of significant studies to

practice [18-22].

This review following all step’s:

Identification of the Theme

Zika virus and nursing care;

Research Question

What care actions performed by nurses for families and pregnant women to prevent and control the Zika virus diseaseare reported in the literature?

Inclusion Criteria

Exploratory, descriptive, analytical, complete scientific papers, among which original studies, reviews, experiencereports, theoretical essays, and reflections addressing nursing care provided to and/or nursing interventionsimplemented with families having pregnant women who were infected with Zika Virus, the full-text of which wereavailable online;



Exclusion Criteria

Publications classified as chronicles, theses, dissertations, letters, book reviews, editorials, book chapters,governmental documents, newsletters, duplicated studies, incomplete papers, and those not available online;

Search Strategies and Sources

The descriptors and key words used in the search were confirmed in the Health Sciences Development (DeCS), VirtualHealth Library (VHL), Table 1, available at: http://decs.bvs.br, retrieved on May 8th, 2018 at 2pm. The descriptors werecombined using Boolean operators: AND, OR or AND NOT, as operators aid inclusion criteria and are essential to thesearch for publications [23].

Table 1. Descriptors and key words. Manaus, Amazonas, Brazil 2019.

Descriptors and Key words

Portuguese English Spanish

Zika Vỉrus Zika Virus Zika Virus

Cuidados do Enfermeiro Nursing actions Cuidado del Enfermero

Mulher Grảvida Pregnant woman Mujer Embarazada

Infeccao Infection Infecciỏn

Famỉlia Family Familia

Gravidez Pregnancy Embarazo

Assistẻncia de Enfermagem Nurse care Asistencia de enfermerỉa

The following databases Table 2 were consulted: Latin American and Caribbean Center on Health Sciences - RegionalLibrary of Medicine (BIREME), Cumulative Index to Nursing and Allied Health Literature (CINAHL), National Library ofMedicine (PubMed), Science Direct, Scientific Electronic Library Online (SciELO), SciVerse Scopus (SCOPUS) and Web ofScience. Papers written in Portuguese, English or Spanish, regardless of year of publication, were identified in September2018, and selected and read from October to December 2018.

Table 2. Number of manuscripts found in each database. Manaus, Amazonas, Brazil in 2018.

Search in the databases

Databases General articles Articles after filters Multiple appearances Articles excluded Articlesselected

BIREME 5,626 4,823 98 696 09

CINAHL 1,987 1,740 73 167 07

PubMed 5,710 5,117 112 475 06

Science Direct 4,589 4,181 45 361 02

SciELO 248 211 12 25 00

SCOPUS 6,080 5,443 87 542 08

Web of Science 5,465 5,093 42 323 07

Total 29,705 26,608 469 2,589 39

Data Extraction and Synthesis

Extracting and synthesizing data from heterogeneous sources is a complex process. All papers were independentlyassessed by two researchers. The following information was abstracted from the included studies: general informationabout authors, publication date, country and language, method and recommendations. Synthesis of the data involved



categorizing: Educational actions/collective prevention, Actions with pregnant women, Avoid getting pregnant- beforeZika virus infection and Professional advice.

RESULTSA total of 29,705 papers were identified in the first consultation of the databases using the descriptor “Zika Virus”;

26,608 of these were excluded after using the filters of free access, full text, and language, employing a combination ofBoolean operators, and applying inclusion and exclusion criteria. Another 469 papers were excluded because theyappeared more than once; that is, the same paper was published in more than one database.

The titles, abstracts and key words of 2,628 papers were read and the full texts of 39 were selected. Two papers wereexcluded after reading the full texts because they did not address the objective proposed here, in that they exclusivelyaddressed the care provided to children. Another 29 papers under the original protocols and protocol update modalitieswere excluded. Thus, a total of eight papers remained and composed the corpus of this review.

The synthesis described here is presented in the PRISMA flowchart Figure 1 [24].

Figure 1. Flowchart presenting the identification and selection of papers published in the databases. Manaus, Amazonas, Brazil2018.

Data were extracted from the papers included in the corpus of this review to compose a synthesis or analysis matrix topresent a general overview of the content obtained [10], as shown on Table 3.

Table 3. Presentation of the papers that compose the corpus of this review. Manaus, Amazonas, Brazil 2018.

N Author/Year/Title Objective Method Recommendations

1 Kadri, MA (2016)

Zika Virus in Brazil: ANew Challenge for the

To inform healthcare providers,especially nurses

Does not mentionthe method used. Thepaper is based on the

- Pregnancy planning;

- PCR testing – Mandatory by the Brazilian Ministry ofHealth;



National Health Systemand Nursing Care.

involved with maternaland child heath, aboutcare.

information anddefinitions provided bythe Brazilian Ministry ofHealth and by theOswaldo CruzFoundation.

- Having a multidisciplinary team to perform long termmonitoring of child, mother and family;

- Using individual protection to prevent mosquito bites,such as repellent, long-sleeved shirts, and trousers

- Implementing control measures to eliminate thevector;

- Public health actions to control and eventuallyeradicate the Zika virus in Brazil: (1) improve social lifeand environmental conditions to eliminate breeding sites;(2) financially support research to broaden knowledgeabout the disease and develop a vaccine; and (3) providehealthcare and social support to the families with childrenwith permanent special needs accruing from the Zikavirus infection.

2 Maharajan et al. (2016)

Zika Virus Infection:Current Concerns andPerspectives

Provide a generaland comprehensivecritical overview ofpeer-reviewed.

Review - Drug therapy;

- Support care and bed rest;

- There is no vaccine available;

- RT-PCR from serum in the 7 days after the beginningof symptoms;

- RT-PCR from saliva and urine. Urine can be used 10days after the beginning of infection;

- Eliminate mosquito breeding sites;

- Decrease Mosquito-Human transmission, urbanareas – individual protection;

- Community surveillance;

- Decrease human-vector contact by using repellent,biological and genetic control;

- Take travel precautions in areas of risk for Zika virusinfection;

- Health education provided to people at risk ofexposure to Zika;

- If exposed to ZIKV, perform assessment andmonitoring during prenatal consultations and recommendsafe sex;

- Prevent blood donor transmission of Zika virus;

- Research addressing Zika virus;

Health providers should:

Pay attention to the early diagnosis of infection causedby Zika virus;

Report suspected cases to public health authorities;

Public education, emphasis on individual andenvironmental preventive measures;

Advise couples at the risk of exposure to the Zika viruswho are planning a pregnancy;

Consult and advise travelers planning to visit endemiccountries in regard to effective preventive measures,apply differential clinical diagnostic testing and be awareof neurological complications;

Differential clinical diagnostics

3 Visovsky et al. (2016)

Zika virus: emergencyand aftercare of patients.

To describe howthe transmissionoccurs; early and lateevidence concerningclinical presentation,diagnostic method,and ways Zika virusspreads infection, as

Review study.Double-blind reviewverified by anti-plagiator software.

Zika prevention:

- Use of repellent;

- Environmental changes (e.g., window screen);

- Eliminate breeding sites;

- Use protective clothing;



well as potentialtherapeutic targets tocontrol microcephalyclinicalmanifestations; andemergency andsupport care. Torecommendpreventiveinterventions.

- Safe sex: using condoms during pregnancy whenhaving sexual intercourse with people who are at the riskof being infected;

Patient education as a responsibility of emergencynurses:

Provide updated knowledge about Zika, especially topregnant women at risk of having contact with infectedindividuals or traveling in areas of infection;

Differential diagnosis;

Educate patients, their families and travelers whosuddenly became ill, presenting signs and symptoms ofthe disease, preventing the spread of the disease;

Recognize signs and symptoms of infection caused byZika among those exposed to the virus;

Identify areas in the community with Zika outbreaks;

Implement community education.

4 Turienzo and Brown(2016)

What should midwivesknow about Zika virusinfection?

To provideinformation aboutZika and its knowneffects duringpregnancy, the clinicalcontrol of pregnantwomen or thoseplanning to becomepregnant, and theimplications of Zikafor the practice ofmidwives in the UnitedKingdom.

Method notidentified

Provisional guidelines:

Pre-trip telephone counseling provided by healthworkers: clinical and traveling guidance;

Clinical assessment of returning travelers withsymptoms (including pregnant women reporting malaise)

General information

Guidance to pregnant women and those planning apregnancy: avoid becoming pregnant while traveling to acountry facing an outbreak of Zika virus infection andeight weeks after returning home.

Nurses and midwives should:

Discuss contraceptive methods and the use ofcondoms;

Pregnant women traveling to areas of risk should takerigorous individual precautions to avoid mosquito bitesand use condoms during sexual intercourse and/orrefrain from sex during pregnancy;

Clinical management of pregnant women exposed tothe Zika virus:

Midwives are recommended to ask all pregnantwomen and their partners about recent or planned trips inevery prenatal consultation;

Seek the support of specialist midwives, obstetriciansand specialists in infectious diseases to assess womenand their partners in regard to the Zika virus;

Laboratory tests seeking evidence of Zika virusinfection.

Perform fetal ultrasound and refer patient to a fetalmedicine service, if necessary;

Pregnant women who present no symptoms two weeksafter returning from an area affected by Zika virus do notneed testing.

Considering that the infection caused by Zika virus isasymptomatic in most cases, baseline fetal ultrasound isrecommended within 28-20 weeks of gestation and thenrepeated in 28-30 weeks;

Male travelers presenting symptoms associated withthe Zika virus and their pregnant partners need Zika virustesting;

Pregnant women exposed to infection caused by Zikavirus whose fetuses were diagnosed with fetal



microcephaly or other brain abnormalities are to bereferred to a fetal medicine unit.

Amniocentesis can be performed using RT-PCR sixweeks after exposure to Zika virus if the woman is ≥ 21weeks of gestation. This procedure should be onlyperformed after thorough counseling due to its potentialcomplications.

Possibility to interrupt pregnancy among womeninfected by Zika virus and having a laboratoryconfirmation that their fetuses present significantmicrocephaly or brain abnormalities.

Midwives should work together with a multidisciplinaryteam and thoroughly discuss with pregnant women therisk of spontaneous abortion or stillbirth and thepossibility of interrupting the pregnancy and managingnewborns.

5 Citil Dogan et al. (2016)

The Zika virus andpregnancy: evidence,management, andprevention.

To analyze existingevidence exhaustively,reports andconsensual guidelinesregarding implicationsduring pregnancy andthe spread of theinfection caused byZika virus (ZIKV).

Bibliographic reviewusing PubMed. Articlebased on theguidelines provided bythe CDC of the Societyfor Maternal-FetalMedicine (SMFM) andby the AmericanCongress ofObstetricians andGynecologists (ACOG)

RT-PCR testing in the first week after the beginning ofsymptoms. Prevent sexual transmission if there isexposure to the virus: use condoms or refrain from sexduring pregnancy.

Guide intended to health workers providing obstetricalcare to manage pregnant women who were potentiallyexposure to Zika virus:

Ultrasound assessment when there is suspected orconfirmed maternal infection: suggested approach

Magnetic resonance imaging (MRI): assessing fetalbrain malformation;

Recommendations to clinically manage symptomsduring pregnancy;

Postpartum and breastfeeding care and congenitalscreening of infection caused by the Zika virus;

Individual and environmental preventive measures;

Family planning;

Biosafety: identify hazards of biological agents andequipment appropriate for individual and environmentalprotection.

6 Millet et al. (2017)

Imported Zika virus in aEuropean city: How toprevent localtransmission?

Describe the firstcases of ZIKVdiagnosed in the cityand analyzesurveillance,prevention and controlmeasuresimplemented to avoidautochthonoustransmission.

Population-basedobservational, cross-sectional studyconducted inBarcelona, Spain.

Individual protection against mosquito bites such as:appropriate clothing, repellent, home confinement duringviremic period, and safe sex;

Community preventive measures;

Health services reorganization;

Protocol for the surveillance and control of mosquito-borne arboviruses transmitted by mosquitoes;

Nurses in the public health should be trained to fullyidentify arboviruses;

Reorganize the hospital structure with physicians fromspecialized hospitals;

Surveillance and early detection of infections causedby Zika virus;

Communicate and disseminate the protocol to all theagents involved – having the arboviruses commission todisclose information through TV shows and news;

Vector control;

Educate patients to seek health services as soon assymptoms appear;

Report all suspected cases of Zika virus;

Provide counseling to travellers;



Report travels to regions with outbreak of Zika virusduring prenatal consultations.

7 Affini et al. (2017)

Conduct of NursesAbout the Zika Virus in thePrenatal Consultation

To identify theknowledge of nursesproviding care topregnant women inFamily Health StrategyUnits in regard topreventive measuresagainst the Zika virus.

Qualitative,deductive, descriptiveand exploratory studyconducted with 13nurses.

Semi structuredinterviews were used tocollect data, whichwere analyzed usingthe Content Analysistechnique.

Continuing education, training and updating workers;preventive measures to control vector.

The authors present and discuss six categories:

1) How to manage nursing consultations duringprenatal care in regard to suspicion of infections by theZika virus: Follow the Women’s Health Protocol providedby the Brazilian Ministry of Health; Report suspicions ofinfection caused by the Zika virus to the epidemiologicalsurveillance; Perform detailed anamnesis and physicalexamination; Differential diagnosis; Instruct pregnantwomen to seek the health unit; Perform active searchthrough home visits, intensifying instructions andreinforcing the need for women to attend prenatalconsultations; Refer women to the PNAR (High RiskPrenatal Care) if infection is confirmed.

2) Instruct pregnant women to prevent infectioncaused by the Zika virus:

by avoiding areas at risk; wearing long-sleeves shirtsand trousers; using condoms, repellents, and windowscreens; and seeking the health unit in case of suspectedinfection caused by the Zika virus.

3) Provide guidance related to complications causedby arboviruses:

Professional qualification; gather groups of pregnantwomen to provide orientation; exchange experiences;establish bonds between workers-pregnant women;promote adherence to prenatal care; and provide holisticcare to pregnant women.

4) Have knowledge of the complications caused byZika virus: microcephaly; CNS is susceptible during theentire period of pregnancy; congenital malformation;hearing and vision problems; mental retardation.Complications vary among children, as there can bemotor, neurological, and/or respiratory problems. Refer tospecialists according to the problem presented by thechild.

5) Recommendations for clinical management:classification of risk; hydration, and monitoring. Thephysician is supposed to establish a differential diagnosisof dengue and Chikungunya; be attentive to the risk ofbleeding of an obstetrical nature associated with the riskof abortion and low-weight at birth; Pregnant women withrash be investigated whether it is caused by the Zikavirus: fetal neurological assessment with arecommendation to perform two extra ultrasoundsbetween the 20th and 24th weeks and between the 32ndand 35th weeks of gestation.

Drug treatment for the symptoms.

6) Insufficient knowledge to provide care to pregnantwomen with infection caused by the Zika virus:

- Continuing education;

- Training for workers to obtain new competencies:leadership, decentralized management; and self-management.

Nursing consultation during prenatal care ensuresquality care, contributes to decrease maternal-fetalmorbidity and mortality, preventing and identifyingpotential congenital malformation such as microcephaly.

8 Santos et al. (2017) To assess thecompetencies of

Quantitative,descriptive and cross-

Devise strategies to prevent and eliminate the vector;

Prevent infection during pregnancy;



Prevencảo da infeccaopelo Zika Vỉrus nasgestantes.

[Prevention of Zikavirus infection amongpregnant women]

Community HealthAgents (CHA) inperforming actionsestablished by theBrazilian Ministry ofHealth during prenatalcare of usual riskwithin the FamilyHealth Strategy scope,in relation topreventing infectioncaused by the Zikavirus duringpregnancy.

sectional study. Datawere collected from 14teams of the HealthFamily Strategy using athree-partquestionnaire: A(fighting Aedesaegypti); B (low riskprenatal care) and C(individual preventivemeasures against theZika virus). Data wereanalyzed using clusteranalysis and Fisher ’ sExact test.

Qualified and humanized prenatal care;

Multidisciplinary approach on the part of healthworkers in order to provide holistic care to pregnantwomen;

The authors also mention contributions to the nursingfield, such as mapping the weaknesses identified in thework of CHAs. These agents are not nursing workers butare under the supervision of nurses, so that scientificevidence is needed to guide the quality of care delivery.

DISCUSSIONPresent in over 70 countries and territories, the Zika virus has become a global threat because there is an intrinsic

possibility of developing neurological congenital syndrome when the infection affects women during the gestationalperiod and presents viral persistency. Therefore, the Zika virus represents a public health problem with a global impact.There was a decrease in suspected cases of ZIKV and warn of the risk of another severe epidemic in Brazil and in othertropical and subtropical countries. For this reason, implementing preventive measures to control vector density andencourage individual and collective protection is of paramount importance [24,25].

Educational actions/collective prevention

Identifying the breeding sites of vectors is a preventive measure that favors the control of vector density, mentioned inall the papers included in the corpus analysis of this review. Notes that public health actions and the control of infectioncaused by the Zika virus in Brazil are related to social life and environmental conditions conducive to the elimination ofthe mosquito breeding sites [6].

Strategies to prevent and control infection caused by the Zika virus require health workers to be qualified andprepared, considering the disease is often asymptomatic. This requires attention because the infections occurring amongpregnant women, and the fact there is vertical transmission, result in neurological abnormalities in fetuses and Guillain-Barre syndrome in adults [26]. GBS is a demyelinating autoimmune pathology that causes acute or subacute flaccidparalysis [9]. Zika epidemics are particularly worrying because infection with this virus can cause Guillain-Barre syndromeand congenital central nervous system malformations including microcephaly [27,28].

Authors consider decreasing the mosquito-to-human spread of the virus in the urban area to be related to the controlof vectors by eliminating potential breeding sites for Aedes aegypti and adopting individual protection to avoid contactwith the vector. Aquatic environments are water storage contexts open to the sky and small puddles are places wheremosquitoes can reproduce [29-31].

In the population-based study conducted in Barcelona, the Surveillance and Pest Control Service conducted anentomological inspection in public areas and in the patient’s home. At the same time, it disseminated informationconcerning the areas, identifying and including areas of risk for the breeding of mosquitoes in the local GeographicInformation System [31].

Orientation regarding how to eliminate potential breeding sites using chemical control as a measure to prevent theirproliferation has been advocated in some studies [29,31,32].

Actions with pregnant women

In the report published by the CDC on measures to prevent infection by the Zika virus during pregnancy, was mentionpurchasing and providing Zika prevention kits as a community intervention strategy, mainly focusing on pregnant women[29]. The kit contains local-adapted health information, repellent, mosquito netting, condoms, and tablets to combat themosquitoes [33].

The individual protection strategies included in the studies are intended to avoid insect bites in the viremic period,especially among pregnant women. For this reason, pregnant women should use safe repellents; insecticides, such aspermethrin spray, on clothes; mosquito netting; light-colored long-sleeved clothing; avoid traveling to endemic areas; anduse screens on windows and doors [29,32,34].



The risk of fetal congenital abnormalities is real, given that pregnant women may be infected by the Zika virus at anygestational age. Clinical guidelines to control exposure to the Zika virus during pregnancy are mainly intended todecrease the contact of people with an infected vector [29,31-32,34-35], while the following measures stand out:

Clinical assessment of pregnant women returning from endemic areas with symptoms;

Visiting a medical center when in an area of high prevalence of ZIKV, if showing signs and symptoms of the disease;

Pregnant women with symptoms or otherwise with sexual partners traveling to outbreak areas, should practicesafe sex (i.e., use condoms or refrain from having sexual intercourse);

Abortion should be decided together with healthcare workers, taking into account the risk-benefit.

The clinical diagnosis of infection caused by the Zika virus is not reliable, because the disease’s clinical andpathological characteristics can be confused with other arboviruses. The laboratory test recommended is RT-PCR, whichshould be performed together with other arboviruses in patients presenting the signs and symptoms of the infection, orthose exposed to areas where there is active Zika virus transmission [6,30,32,34-35].

Material for testing should be collected in the viremic period, within seven days after the onset of symptoms. Urine canbe collected for up to 20 days, after which [36].

After obtaining a laboratory exam confirming infection caused by the Zika virus, authors recommend performingbaseline fetal ultrasound. If an ultrasound reveals the fetus has a congenital syndrome arising from Zika, the patientmust be referred to a fetal medicine service and/or to a high-risk prenatal care service [34-35]. According to guidelinesprovided by the Brazilian Ministry of Health, if an ultrasound reveals no abnormalities, pregnant women should bemonitored by a high-risk prenatal care service [37]. The Zika virus can infect pregnant women at any time during thegestational period. The first trimester of pregnancy, however, is when there is the greatest incidence of congenitalmalformation caused by the virus. Health providers should advise pregnant women and their families to be attentive tothe risk that obstetrical bleeding may lead to the risk of spontaneous abortion, stillbirth or termination of pregnancy[34-35].

It important of decisions made at the individual and social level considering social inequality, a lack of effective vector-prevention programs, the existence of abortion-restrictive laws in some countries, difficult access to contraceptivemethods and sexual education programs, that is, that decisions may be made in a context of uncertainty, which mayharm the health and wellbeing of pregnant women even more, requiring high-risk ante care [3].

Avoid getting pregnant – before Zika virus infection

We also found in this review advice for women who are planning a pregnancy: Avoid becoming pregnant if living ortraveling to a country where there is active local ZIKV transmission and eight weeks after returning home. Nurses andmidwives should recommend efficacious contraceptive methods and the use of condoms for couples when at least onepartner has visited an area with active Zika infection [34].

Professional advice

Actions to prevent and control the spread of the Zika virus are implemented by a multidisciplinary team in order todevelop protocols. Health workers play an essential role during prenatal care by screening pregnant women suspected ofbeing infected with Zika virus, or confirmed to be infected. The studies [6,29-32,34-35] report that the responsibilities ofhealth workers include:

Reorganize public health services;

Provide pre-trip telephone counseling - Clinical guidance and preventive care during travel;

Educate pregnant women, their families and the community in regard to individual and environmental preventivemeasures;

Stay up to date;

Midwives are oriented to ask questions in all prenatal consultations to all pregnant women and their partners in orderto obtain information and advise on recent and planned trips;

Seek the support of specialists in infectious diseases when there is suspicion of infection by the virus;

Midwives should work together with a multidisciplinary team;

Discuss with pregnant women about the risk of spontaneous abortion or stillbirth and analyze the possibility ofinterrupting the pregnancy if infection by the Zika virus is confirmed;



.

.

.

.

.

.

.

.

.

.

.

.

Midwives have the responsibility of staying up-to-date in regard to local guidelines and protocols to accurately assesspregnant women exposed to the Zika virus;

Provide health education to patients, community and multidisciplinary team;

Early diagnosis of infection caused by the Zika virus via laboratory exam when there is a suspicion of infection;

Report the infection to the agency responsible for epidemiological surveillance;

Differential diagnosis of other mosquito-borne infectious diseases, such as Dengue and Chikungunya;

Public health nurses must know arboviruses, specific epidemiological situation, and make appropriate records of eachcase;

Emergency nurses should be able to recognize the signs and symptoms of infection and appropriately refer patients;

Health workers such as nurses, midwives and CHAs should be aware of the neurological complications associated withthe Zika virus and its social and economic impact on families and society [6,29,32,34-36].

The study carried out in the south of Minas Gerais, Brazil, and assesses the competencies of CHAs in the developmentof their responsibilities as established by the Brazilian Ministry of Health [37]. Weaknesses were identified in the workperformed to combat Aedes aegypti in relation to vector control. The authors mention the responsibility of nurses workingin the Family Health Strategy to supervise these agents and seek scientific evidence to ground the delivery of quality care[38].

Neurological disorders can be diagnosed during pregnancy. The virus has a tropism to the neuronal cells at any stageof a pregnancy, affecting neuronal precursor cells, isolated in the brain tissue and cerebrospinal fluid of children withcongenital syndromes [39]. Therefore, there is a need to support research financially and establish worldwidecollaboration to expand knowledge of the disease and develop a vaccine [6,29].

Note that, even though the term Zika virus originated in consultation with databases, totaling 29,705 papers, specificstudies addressing the care provided by nurses to families and pregnant women and the prevention and control of thisinfection are still incipient. This fact should be noted because the first study addressing the Zika virus dates back to1947, while the first outbreak occurred more than ten years ago. Thus, training nurses to observe and acquire knowledgeof emergent diseases in society, as well as epidemics, is an important professional commitment that must be ethicallyfulfilled through education, research and dissemination of knowledge.

CONCLUSIONA small number of studies was obtained after applying inclusion and exclusion criteria, as few papers reported the care

provided by nurses or nursing care provided to families and pregnant women aiming to prevent and control infectioncaused by the Zika virus.

The papers that compose the corpus of analysis in this review do not report the specific actions of nurses. The reportsincluded: care in regard to the environment; individual protection of pregnant women; guidance provided to travelers;differential diagnosis in relation to other viral diseases; education provided to the nursing staff, families and pregnantwomen; health care and social support provided to families with children with permanent special needs arising frominfection caused by Zika virus; and mandatory reporting of suspected and confirmed cases of the disease.

Considering that the professional nurse performs clinical practice in various care services is essential to participate inclinical research, especially multicenter. This will unveil new nursing techniques and technologies for the prevention andcontrol of Zika virus infection, especially in pregnant women. As well, assess the economic and social impact of thisinfection.

REFERENCES1. Dick GW, et al. Zika Vírus (I): Isolations and serological specificity. Trans. R. Soc. Trop. Med. Hyg

1952;46:509-520.

2. Brunoni D, et al. Microcephaly and other manifestations related to Zika virus: impact on children, families andhealth teams. Public Health Science 2016; 21:3297-3302.

3. Diniz SG. Zika virus and pregnancy: A perspective from Brazil. Midwifery 2016;35:22-23.

4. Diniz D, et al. Zika virus infection in Brazil and human rights obligations. Int. J. Gynecol. Obstet2017;136:105-110.



..

.

.

.

.

.

.

.

5. Brasil. Surveillance protocol and response to microcephaly and / or central nervous system (CNS) changes.Brasilia: Ministry of Health 2015.

6. Kadri MR. Zika Virus in Brazil: A new challenge for the national health system and nursing care. Int. J. ChildbirthEduc 2016;31:26-28.

7. Harris LH, et al. The paradigm of the paradox: Women, pregnant women, and the unequal burdens of the Zikavirus pandemic. Am. J. Bioeth 2016;16:1-4.

8. Brazil Ministry of Health. Secretariat of Health Surveillance. Department of Communicable Disease Surveillance.Surveillance protocol and response to microcephaly and / or Central Nervous System (CNS) changes. Ministry ofHealth, Health Surveillance Secretariat, Communicable Disease Surveillance Department. Brasilia: Ministry ofHealth, 2015.

9. Pereira AM, et al. Zika virus and pregnancy in Brazil: What happened? J Turk Ger Gynecol Assoc 2018;19:39-47.

10. Brazil. Health Surveillance Secretariat. Health Care Secretariat. Zika: Clinical approach in primary care. Brasilia(DF): FIOCRUZ, 2016.

11. Brazil. Ministry of Health. Health Surveillance Secretariat. Integrated monitoring of growth and developmentalchanges related to Zika virus infection and other infectious etiologies, by Epidemiological Week 14/2017.Epidemiological Bulletin 2017;48:1-9.

12. Garcia LP. Zika virus epidemic and microcephaly in Brazil: Emergence, evolution and coping. Institute of AppliedEconomic Research. Brasilia, February 2018.

13. Brown C. Zika virus outbreaks in Asia and South America. CMAJ: Canadian Medical Association journal: Journal deAssociation medicale canadienne 2016;88:34.

14. Chaves RR, et al. Systematization of nursing care: overview of nurses. Rev. Enferm. UFPE on line2016;10:1280-1285.

15. Costa ES, et al. Mothers’ experiences of children with microcephaly. Rev Rene 2018:19.

16. Alvarado MG and Schwartz DA. Zika Virus infection in pregnancy, microcephaly, and maternal and fetal healthwhat we think, what we know, and what we think we know. Arch. Pathol. Lab. Med 2017;141:26-32.

17. Britto IT, et al. Being mother of a child with microcephaly. Fisioter Bras 2019;20:384-391.

18. Whittemore R and Knafl K. The integrative review: update methodology. J Adv Nurs. 2005;52:546-53.

19. Mays N, et al. Systematically reviewing qualitative and quantitative evidence to inform management and policy-making in the health field. J. Health Serv. Res. Policy 2005;10:6-20.

20. Goldsmith MR, et al. Synthesising quantitative and qualitative research in evidence-based patient information. J.Epidemiol. Community Health 2007;61:262-270.

21. Polit DF and Beck CT. Fundamentals of nursing research: evidence evaluation for nursing practice. Trad. DeniseRegina de Sales; technical review: Anna Luz MH, Fensterseifer LM, Luce Kruse MH (Eds). 7th ed. Porto Alegre:Artmed 2011.

22. Botelho LR, et al. The Integrative Review Method in Organizational Studies. Management and Society2011;5:121-136.

23. Cunha PLP, et al. Manual bibliographic review integrative systematic: An evidence-based research. Belo Horizonte:Distance Learning 2014.

24. Liberati A, et al. The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies ThatEvaluate Health Care Interventions: Explanation and Elaboration. PLOS Medicine 2009;6:e1000100.

25. Esposito DL, et al. Current priorities in the Zika response. Immunology 2017;153:435-442.

26. Rather IA, et al. Prevention and control strategies to conter Zika epidemic. Front. Microbiol 2017;8(305).

27. Costello A, et al. Defining the syndrome associated with congenital zika virus infection. Bulletin of the World HealthOrganization 2016;94:406-406a.

28. Cao-Lormeau VM, et al. Guillain-Barre Syndrome outbreak associated with Zika virus infection in French Polynesia:a case-control study. Lancet 2016; 387:1531-1539.



29. Maharajan MK, et al. Zika virus infection: Current concerns and prospects. Clinic Rev. Allerg. Immunol2016;51:383-394.

30. Visovsky C, et al. Zika virus: Emergency and aftercare of patients. Emerg. Nurse 2016;24:20-23.

31. Millet JP, et al. Imported Zika vírus in a European city: How to prevent local transmission? Front. Microbiol2017;8:1319.

32. Citil Dogan A, et al. The Zika virus and pregnancy: Evidence, management, and prevention. J. Matern. FetalNeonatal Med 2016;30:386-396.

33. D'Angelo DV, et al. Measures taken to prevent Zika Virus infection during pregnancy - Puerto Rico, 2016. MMWRMorb. Mortal. Wkly. Rep 2017;66:574-578.

34. Turienzo CF and Brown M. What should midwives know about Zika virus infection? Br. J. Midwifery 2016;24:694.

35. Affini AMS, et al. Nurses' conduct regarding Zika virus in prenatal consultation. Rev. Enferm. UFPE2017;11:5231-5244.

36. Al-Afaleq AI. Zika Virus disease. Saudi J. Med. Sci 2017;5:2-8.

37. Brasil. Attention to low risk prenatal care. (Series A. Standards and Technical Manuals) (Primary Care Books, #32). Brasilia: Ministry of Health 2012.

38. Santos D, et al. Prevention of Zika virus infection in pregnant women. Rev. Enferm. UFPE 2017;11:5339-5353.

39. Carvalho NS, et al. Zika virus and pregnancy: An overview. Am. J. Reprod. Immunol 2017;77(2):12616.



Documents

Nursing Care Actions to Prevent and Control the Zika Virus ...€¦ · Nursing is a science, the essence and specificity of which is human care, that is, integral care centered on